POEMS syndrome-characterized by
polyneuropathy, organomegaly, endocrinopathy, M-
protein, and skin changes-is an uncommon and complex paraneoplastic disorder encompassing a diverse array of symptoms. Here we report the challenging case of a 34-year-old female who sought medical attention at the emergency department due to distal lower limb weakness. She was breastfeeding her first child at that time. Her condition rapidly deteriorated, making it difficult for her to perform simple tasks independently. Initially, she struggled with activities like jumping or climbing stairs. Eventually, her ability to walk was also compromised. These symptoms underscored the swift evolution of her
polyneuropathy. Nerve conduction studies and electromyography confirmed a diagnosis of mixed demyelinating and axonal
polyneuropathy. Subsequent investigations, including bone marrow biopsy and immunochemistry testing, revealed a plasma cell disorder characterized by lambda
monoclonal gammopathy, along with elevated levels of
vascular endothelial growth factor (
VEGF > 8000 pg/mL). This pivotal finding led to the diagnosis of
POEMS syndrome, prompting the initiation of
antineoplastic therapy (
daratumumab-
lenalidomide-
dexamethasone) to manage this condition. An autologous
cell transplantation was planned. The rarity of
POEMS syndrome and its diverse clinical manifestations often lead to an incorrect or delayed diagnosis. Our case underscores the importance of considering this syndrome in patients presenting with acute or subacute
polyneuropathy, even if the patients are young. In conclusion, this case elucidates the diagnostic complexities of
POEMS syndrome, emphasizing the integral role of comprehensive multidisciplinary evaluations and the potential influence of increased
VEGF as a diagnostic key
element and possible therapeutic target.